Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Dr. John Wagner can screen 6 million people worldwide in search of a perfect bone marrow match for one of his leukemia patients. Yet, finding that match is often impossible.

“Sixty percent, if not more, can’t go on because they can’t find a donor,” said Wagner, who works at the University of Minnesota Cancer Center.

Prospects may improve in coming years for the 15,000 blood cancer patients each year who can’t find suitable transplants.

The federal government is moving aggressively to create the first national banking system for umbilical cord blood, which contains the same potentially lifesaving stem cells as bone marrow — but with a distinct advantage.

They don’t require that the donor and recipient share the same group of genes essential to getting a transplant to take. As a result, they are less likely to be rejected by the recipient.

“We can find donors for everyone. When I say everyone, upward of 90 percent,” Wagner said.

Last year, the Institute of Medicine took note of the promise of cord blood in a report that called for more federal funding to increase supply and to make it easier for doctors to find the best match for their patients.

The federal government is taking steps to fulfill those recommendations.

The Health Resources and Services Administration recently awarded contracts totaling nearly $10 million to coordinate cord blood donations and to monitor the outcome of transplants.

And, any day now, the agency will award about $14 million to public cord blood banks around the country. The goal: Increase the supply of cord blood donations from 50,000 to 150,000.

The increased supply is particularly important for minority patients. Most bone marrow donors are white, so bone marrow donations mostly help white recipients.

“The problem has been lack of access, lack of diverse specimens and just a gross lack of capacity,” said Rep. Chris Smith, R-N.J., who co-sponsored the legislation that authorized the funding. “The utilization rates for cord blood are going to skyrocket.”

Expand cord blood supplyThe New York Blood Center is one of the public banks competing for the money. The center has perhaps the largest collection of cord blood units in the world — about 35,000 units. Most of the nearly two dozen public banks rely on private donations to operate.

“In our case, since we’ve built up such a large inventory, it’s just about break-even,” said Dr. Robert Jones, the center’s president.

But, for smaller cord blood banks, it’s often tougher to make ends meet, he said.

“Now, they’ll have the dollars to get started or to expand their inventory,” he said.

Jones said that processing a unit of cord blood costs between $1,000 and $2,000, depending on how it is collected and stored, and the location of the bank itself. The federal funding won’t pay the full collection cost, but the subsidy should be enough to substantially expand the cord blood supply, Jones said.

Jones doesn’t anticipate that collecting thousands of new donations will pose a problem. Many women would be glad to donate their child’s umbilical cord to a public bank, but have no way of doing so. Their opportunity for donation will surely expand as new banks open and others expand. His company, for example, has three new hospitals coming online as collection points in the next year.

Overall, Congress authorized spending up to $15 million a year on cord blood collections over the next four years. An additional $19 million has already been appropriated.

Besides expanding collections, the government will fund the development of an information center for cord blood donations. The center will allow doctors to make one phone call to find the best match for a patient, regardless of where in the country the blood is stored. That money was awarded last month to the National Marrow Donor Program in Minneapolis.

Also, the Medical College of Wisconsin won a contract worth more than $6 million to analyze the outcomes of blood stem cell transplants.

“For us to understand how good cord blood is compared to marrow, we need to have a central data base that collects data on every one, every marrow recipient, every cord blood recipient,” Wagner said. “This will allow us to really understand how well cord blood works for every individual type of disease, for every different population of patients.”

Wagner, who served on the medical team that performed the first cord blood transplant in the world for a leukemia patient, said scientists are just now learning about the potential benefits of cord blood stem cells.

So far, only about 8,000 cord blood transplants have been performed worldwide, he estimated, but that number is growing quickly. Scientists are also learning new ways to use the cord blood stem cells. For instance, doctors are combining cord blood units to allow for the treatment of adults. Primarily, cord blood transplants have been reserved for children because the amount of stem cells in a single donation isn’t enough to help an adult, he said.

Also, scientists are moving beyond using cord blood merely as a way to rescue the bone marrow. Wagner said that scientists have isolated cord blood stem cells that can kill leukemia. Now, they’re testing those cells in the treatment of other diseases, such as diabetes and lupus.

“We now find all these novel uses that are just now being explored,” Wagner said. “It will take more time for us to prove how effective they are, but there are very unusual types of cells in cord blood that make us particularly excited about it as a new source of cells for many more types of therapy than we ever imagined in the past.”